CMR-derived Myocardial Strain In Asymptomatic Heart Transplanted Patients And Its Correlation With Late Gadolinium Enhancement

Objectives(1)To investigate whether cardiovascular magnetic resonance(CMR)-derived myocardial strains were abnormal in asymptomatic heart transplantation(HT)patients with normal left ventricular ejection fraction(LVEF);(2)to detect the relationship between CMR-derived myocardial strain parameters and late gadolinium enhancement(LGE)in asymptomatic HT patients.MethodsA total of 72 consecutive HT patients who underwent routine clinical examination in our hospital and without adverse clinical symptoms from September 2018 to June 2019 and 35 healthy volunteers with no history of heart-related disease were recruited.All subjects underwent 1.5-T MR scans.The examination protocol included basic cine imaging and LGE.The deformation registration algorithm(DRA)and feature tracking(FT)software were used for myocardial strain analyses.Myocardial strain included left ventricular global longitudinal strain(LVGLS),LV global circumferential strain(LVGCS),LV global radial strain(LVGRS)and right ventricular longitudinal strain(RVLS).A threshold 4 standard deviations(SD)above the mean signal intensity of the remote normal myocardium from the same slice was used to quantify LGE.And LGE was divided into infarct-typical form and infarctatypical form.Results1): 72 HT patients(20 females)at a median of 3.3 years after HT and 35 healthy volunteers(11 females)were recruited in our study.Compared with healthy volunteers,HT patients had similar LVEF(64.5±7.9 vs 62.2±5.0;p=0.2)whereas lower RVEF(46.1±6.4 vs 49.8±3.3,p<0.001).HT patients had significantly decreased LVGLS(DRA:-10.6 ± 2.0 vs-14.7 ± 2.1,p<0.001;FT:-15.2±3.0 vs-19.4 ± 2.5,p<0.00)、LVGRS(DRA:32.4 ± 11.0 vs 39.1 ± 8.3,p=0.001;FT: 30.6 ± 7.7 vs 35.4 ± 8.0,p=0.004)、LVGCS(DRA:-13.5 ± 3.4 vs-16.4 ± 1.7,p<0.001;FT:-17.9±2.9 vs-19.9 ± 2.6,p<0.001)和 RVLS(DRA:-14.4 ± 3.3 vs-17.6 ± 2.7,p<0.001;FT:-17.8 ± 4.1 vs-21.6 ± 4.2,p<0.001).2): In this study,26 HT patients had LGE(+),1 patient was infarct-typical LGE and other 25 patients were infarct-atypical LGE.46 HT patients had LGE(-).Compared the HT patients with LGE(-),the patients with LGE(+)had lower LVGLS(DRA:-9.86±2.31 vs-11.11±1.73,p=0.0128;FT:-13.52±3.04 vs-16.09±2.69,p=0.001)and LVGRS(DRA: 29.75 ± 8.7 vs 34.40 ± 11.25,p=0.025;FT:27.97 ± 7.14 vs 32.7±7.9,p=0.042)and similar LVGCS(DRA:-13.2±2.31 vs-13.90±3.88,p=0.06;FT:-17.02±3.06 vs-18.71±2.66,p=0.055).The receiver operating characteristic(ROC)and logistic regression analyses showed that the CMR-derived LVGLS and LVGRS measurements were significantly associated with the presence of LGE(+).Multivariate logistic regression showed that DRA-and FT-LVGLS were independently related to LGE(+).The odds ratio(OR)for DRA-LVGLS was 1.340,1.342,respectively.ConclusionsThe decrease of CMR-derived myocardial strain measurements occurred in asymptomatic HT patients with normal LVEF.The CMR-derived LVGLS was independently related to the presence of LGE in these patients.